HSAA AMENDING AGREEMENT THIS AMENDING …...HSAA AMENDING AGREEMENT THIS AMENDING AGREEMENT (the...

HSAA AMENDING AGREEMENT

THIS AMENDING AGREEMENT (the “Agreement”) is made as of the 1st day of July, 2019

B E T W E E N :

(the “LHIN”)

(the “Hospital”)

AND

WHEREAS the LHIN and the Hospital (together the “Parties”) entered into a hospital service accountability agreement that took effect April 1, 2018 (the “HSAA”);

NOW THEREFORE in consideration of mutual promises and agreements contained in this Agreement and other good and valuable consideration, the Parties agree as follows:

1.0 Definitions. Except as otherwise defined in this Agreement, all terms shall have the meaning ascribed to them in the HSAA. References in this Agreement to the HSAA mean the HSAA as amended and extended.

2.0 Amendments.

2.1 Agreed Amendments. The HSAA is amended as set out in this Article 2.

2.2 Amended Definitions.

The following terms have the following meanings.

“Schedule” means any one of, and “Schedules” means any two or more as the context requires, of the Schedules appended to this Agreement, including the following:Schedule A: Funding AllocationSchedule B: ReportingSchedule C: Indicators and Volumes

C.1. Performance IndicatorsC.2. Service VolumesC.3. LHIN Indicators and VolumesC.4. PCOP Targeted Funding and Volumes

HSAA AMENDING AGREEMENT — 2019- 20 SCHEDULES of 11

2.3 Term. This Agreement and the HSAA will terminate on March 31, 2020.

3.0 Effective Date. The amendments set out in Article 2 shall take effect on April 1, 2019. All other terms of the HSAA shall remain in full force and effect.

4.0 Governing Law. This Agreement and the rights, obligations and relations of the Parties will be governed by and construed in accordance with the laws of the Province of Ontario and the federal laws of Canada applicable therein.

5.0 Counterparts. This Agreement may be executed in any number of counterparts, each of which will be deemed an original, but all of which together will constitute one and the same instrument.

THE BALANCE OF THIS PAGE IS INTENTIONALLY LEFT BLANK.


Hospital Service Accountability Agreements

2019-2020 Schedule A Funding Allocation

2019-2020

$7,675,399

$47,513,987

$1,514,295

$1,501,910

$4,615,712

$1,506,869

Sub-Total Non-LHIN Funding $9,478,786

Other Non-HSFR Funding (Sec. 5)

Sub-Total LHIN Funding

$0

$1,505,600

[3] Cancer Care Ontario and the Ontario Renal Network

[2] Base

$12,443,359

$20,607,555

Recoveries and Misc. Revenue

Amortization of Grants/Donations Equipment

OHIP Revenue and Patient Revenue from Other Payors

Differential & Copayment Revenue $340,000

640

Collingwood General and Marine Hospital


NON-LHIN FUNDING

LHIN FUNDING

Facility #:

Hospital Name:

Hospital Legal Name:

$0

$1,505,600

LHIN Global Allocation (Includes Sec. 3)

Health System Funding Reform: HBAM Funding

Section 1: FUNDING SUMMARY

[2] Incremental/One-Time

Provincial Program Services ("PPS") (Sec. 4 ) $0

Post Construction Operating Plan (PCOP)

[1] Estimated Funding Allocation

$6,014,651

Health System Funding Reform: QBP Funding (Sec. 2)

$0

Wait Time Strategy Services ("WTS") (Sec. 3) $773,023




2019-2020


Facility #: 640

Hospital Name: Collingwood General and Marine Hospital

Hospital Legal Name: Collingwood General and Marine Hospital

Acute Inpatient Stroke Hemorrhage 4 $25,412

Acute Inpatient Stroke Ischemic or Unspecified 51 $422,025

Section 2: HSFR - Quality-Based Procedures Volume [4] Allocation

Hip Replacement BUNDLE (Unilateral) 83 $758,537

Knee Replacement BUNDLE (Unilateral) 130 $1,069,380

Acute Inpatient Stroke Transient Ischemic Attack (TIA) 30 $95,130

Stroke Endovascular Treatment (EVT) 0 $0

Elective Hips - Outpatient Rehab for Primary Hip Replacement 0 $0

Acute Inpatient Primary Unilateral Knee Replacement 0 $0

Acute Inpatient Primary Unilateral Hip Replacement 0 $0

Rehabilitation Inpatient Primary Unlilateral Hip Replacement 0 $0

Acute Inpatient Primary Bilateral Joint Replacement (Hip/Knee) 5 $56,870

Rehab Inpatient Primary Bilateral Hip/Knee Replacement 0 $0

Rehabilitation Inpatient Primary Unlilateral Knee Replacement 0 $0

Elective Knees - Outpatient Rehab for Primary Knee Replacement 0 $0

Knee Arthroscopy 171 $263,430

Acute Inpatient Congestive Heart Failure 153 $1,042,695

Rehab Outpatient Primary Bilateral Hip/Knee Replacement 0 $0

Acute Inpatient Hip Fracture 124 $1,346,516

Acute Inpatient Non-Cardiac Vascular Aortic Aneurysm excluding Advanced Pathway 0 $0

Acute Inpatient Non-Cardiac Vascular Lower Extremity Occlusive Disease 0 $0

Acute Inpatient Chronic Obstructive Pulmonary Disease 187 $1,139,765

Acute Inpatient Pneumonia 77 $428,043

Unilateral Cataract Day Surgery 0 $0

Retinal Disease 0 $0

Acute Inpatient Tonsillectomy 6 $5,904

Non-Emergent Spine (Non-Instrumented - Day Surgery) 0 $0

Non-Emergent Spine (Non-Instrumented - Inpatient Surgery) 0 $0

Non-Routine and Bilateral Cataract Day Surgery 0 $0

Corneal Transplants 0 $0

Shoulder (Reverse Arthroplasties) 0 $0

Shoulder (Repairs) 136 $381,750

Non-Emergent Spine (Instrumented - Inpatient Surgery) 0 $0

Shoulder (Arthroplasties) 19 $147,668

Shoulder (Other) 68 $172,313

Hysterectomy 43 $192,296

Other QBP

Post QBP Mitigation for Medium Hospital 0 $127,665

Sub-Total Quality Based Procedure Funding 1,287 $7,675,399




Facility #: 640



2019-2020


Section 3: Wait Time Strategy Services ("WTS") [2] Base [2] Incremental Base

General Surgery $255,431 $0

Magnetic Resonance Imaging (MRI) $0 $0

Ontario Breast Screening Magnetic Resonance Imaging (OBSP MRI) $0 $0

Pediatric Surgery $0 $0

Hip & Knee Replacement - Revisions $17,592 $0

Computed Tomography (CT) $500,000 $0

Sub-Total Wait Time Strategy Services Funding $773,023 $0

Other Cardiac Services $0 $0

Organ Transplantation $0 $0

Section 4: Provincial Priority Program Services ("PPS") [2] Base [2] Incremental/One-Time

Cardiac Surgery $0 $0

Regional Trauma $0 $0

Neurosciences $0 $0

Bariatric Services $0 $0

Sub-Total Provincial Priority Program Services Funding $0 $0

Section 5: Other Non-HSFR [2] Base [2] Incremental/One-Time

LHIN/MOH Recoveries $0

Other Revenue from MOHLTC $4,301,938

Paymaster $1,712,713

LHIN One-time payments $0 $1,505,600

MOH One-time payments $0 $0

Grant in Lieu of Taxes (Inc. in Global Funding Allocation Sec. 1) $0 $6,150

[3] Ontario Renal Network Funding (Inc. in Cancer Care Ontario Funding Sec. 4) $0 $0

Sub-Total Other Non-HSFR Funding $6,014,651 $1,505,600

Section 6: Other Funding(Info. Only. Funding is already included in Sections 1-4 above) [2] Base [2] Incremental/One-Time

[2] Funding allocations are subject to change year over year.

[3] Funding provided by Cancer Care Ontario, not the LHIN.

[4]All QBP Funding is fully recoverable in accordance with Section 5.6 of the H-SAA. QBP Funding is not base funding for the purposes

of the BOND policy.

Sub-Total Other Funding $0 $6,150

[1] Estimated funding allocations.


`

Hospital Service Accountability Agreements640



Facility #:

Hospital Name:


Fiscal Year

30 April 2020

2. Hospital Quartery SRI Reports and Supplemental Reporting as Necessary

31 May 2020

07 November 2019

2019-2020 Schedule B: Reporting Requirements

Q4 – January 01 to March 31

Year End

Q3 – October 01 to December 31 07 February 2020

30 June 2020

31 October 2019

31 January 2020

Q2 – April 01 to September 30

Q2 – April 01 to September 30

Q3 – October 01 to December 31

1. MIS Trial Balance

Q4 – January 01 to March 31 7 June 2020

3. Audited Financial Statements

4. French Language Services Report

Fiscal Year

30 June 2020



2019-2020 Schedule C1 Performance Indicators

Facility #:

Hospital Name:


Site Name:



TOTAL ENTITY

Part I - PATIENT EXPERIENCE: Access, Effective, Safe, Person-Centered

Performance

Target

Performance

Standard

2019-2020 2019-2020

5.4 <= 5.9

3.3 <= 3.6

66% >= 66%

66% >= 66%

n/a #VALUE!

90% >= 90%

14.0% <= 15.4%

0.2 <=0.3

Hospital Standardized Mortality Ratio (HSMR)

Rate of Ventilator-Associated Pneumonia

Rate of Hospital Acquired Methicillin Resistant Staphylococcus Aureus Bacteremia

Central Line Infection Rate

Percent of Priority 2, 3, and 4 cases completed within Access targets for Cardiac By-Pass Surgery

Percent of Priority 2, 3, and 4 cases completed within Access targets for Cancer Surgery

Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for Cataract Surgery

90th Percentile Time to Disposition Decision (Admitted Patients)

Explanatory Indicators

90th Percentile Emergency Department (ED) length of stay for Non-Admitted High Acuity (CTAS I-III)

Patients

90th Percentile Emergency Department (ED) length of stay for Non-Admitted Low Acuity (CTAS IV-V)

Patients

Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for Hip Replacements

Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for Knee Replacements

Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for MRI

Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for CT Scans

Readmissions to Own Facility within 30 days for selected HBAM Inpatient Grouper (HIG) Conditions

*Performance Indicators

Rate of Hospital Acquired Clostridium Difficile Infections

Percent of Stroke/TIA Patients Admitted to a Stroke Unit During Their Inpatient Stay



2019-2020 Schedule C1 Performance Indicators

Facility #:

Hospital Name:


Site Name:



TOTAL ENTITY

Part II - ORGANIZATION HEALTH - EFFICIENCY, APPROPRIATELY RESOURCED, EMPLOYEE EXPERIENCE, GOVERNANCE

Performance

Target

Performance

Standard

2019-2020 2019-2020

0.29 >= 0.28

(2.82%) >=(2.82%)

Performance

Target

Performance

Standard

2019-2020 2019-2020

20% <= 22%

Part III - SYSTEM PERSPECTIVE: Integration, Community Engagement, eHealth

Alternate Level of Care (ALC) Rate



Part IV - LHIN Specific Indicators and Performance targets: See Schedule C3

Targets for future years of the Agreement will be set during the Annual Refresh process.

*Refer to 2019-2020 H-SAA Indicator Technical Specification for further details.

Percentage of Acute Alternate Level of Care (ALC) Days (Closed Cases)

Repeat Unscheduled Emergency Visits Within 30 Days For Mental Health Conditions

Repeat Unscheduled Emergency Visits Within 30 Days For Substance Abuse Conditions

Current Ratio (Consolidated - All Sector Codes and fund types)

Adjusted Working Funds/ Total Revenue %


Total Margin (Hospital Sector Only)

Total Margin (Consolidated - All Sector Codes and fund types)




2019-2020 Schedule C2 Service Volumes

Performance

Target Performance Standard

2019-2020 2019-2020

Clinical Activity and Patient Services

26,067 >= 19,550 and <= 32,584

0 -

863 >= 734 and <= 992

0 -

1,496 >= 1,346 and <= 1,646

37,000 >= 29,600 and <= 44,400

0 -

0 -

5,617 >= 5,168 and <= 6,066Total Inpatient Acute Weighted Cases

Inpatient Mental Health Patient Days

Facility #:



Visits

Measurement Unit

Emergency Department Weighted Cases

Emergency Department and Urgent Care Visits

Complex Continuing Care Weighted Patient Days

Elderly Capital Assistance Program (ELDCAP) Patient Days

Day Surgery Weighted Cases

Ambulatory Care

Inpatient Rehabilitation Days Patient Days



System Collaboration on Health Systems Planning and Design

HSPs are required to collaborate with system partners to support the development of an integrated system of health services that provides person-centered, timely,

equitable, accessible, high quality, and evidence-based services in an efficient, effective and sustainable manner. (Referred to as “Care Connections - Partnering for

Healthy Communities” and “Care Connections Refresh”).

To ensure optimal alignment across the region, the HSP agrees that the development and submission of organizational plans and proposals to the LHIN will

incorporate, where applicable, the following considerations:

• the needs of patients, clients and/or residents;

• NSM LHIN System priorities (as outlined in the NSM LHIN Integrated Health Services Plan (IHSP), NSM LHIN Annual Business Plans, and NSM

LHIN Annual CEO deliverables as posted on the NSM LHIN website);

• Feedback from LHIN Leadership Council and relevant Coordinating Councils; and,

• Coordination and collaboration within NSM LHIN geographic sub-regions, where applicable.

The HSP understands that as a partner in the local health system, it has an ongoing obligation to provide input, where requested, on the content of strategic

directions and plans for the geographic sub-regions of the NSM LHIN. Further, the HSP agrees to participate in the work and initiatives of all Coordinating Councils

and Project Steering Committees, to the extent that it is able without impacting its capacity to meet its other obligations under this agreement. Such initiatives

include, but are not limited to:

• Participation and collaboration of a LHIN-approved senior executive of the HSP as a member of the oversight council

(“referred to as the “Leadership Council”), a Coordinating Council and/or a Project Steering Committee to implement such recommendations as

are agreed to by the Leadership Council and NSM LHIN Board of Directors;

• Identification of Coordinating Council project leads and/or project champions;

• Participation in regional/provincial planning and implementation groups; and,

• Specific obligations as may be specified as a condition of participation in Council initiatives (outlined in the Project Charter for the initiative).

Risk Management Reporting to the LHIN

HSP Boards will ensure that:

• The HSP has an organization-specific policy related to the management of risks;

• Significant and major risks are identified and reported promptly to the LHIN in the manner outlined in the “NSM LHIN Risk Management Reporting

Guidelines and Manual” (available on the NSM LHIN website); and,

• All significant and major risks are assigned action plans to mitigate likelihood and/or impact, and that status updates for unmitigated risks are

provided to the LHIN periodically until the risk is no longer significant.

Indigenous Report Submission

HSPs are required to complete the Indigenous Annual Report for the period of April 1 to March 31. The NSM LHIN will provide a separate communication to HSPs

with a link to the electronic report template. The report will be used to:

• Identify and track opportunities for Indigenous Cultural Safety and Aboriginal Cross Cultural Awareness training; and,

• Support HSPs with voluntary self-identification.

Reporting is due to the NSM LHIN by April 30 annually.

Satisfaction Survey Results Reporting to the LHIN

All NSM LHIN funded HSPs are required to provide a report annually to the LHIN outlining the efforts made to collect information on the experience of persons

receiving services from the organization and/or to solicit views about the quality of care provided by the HSP.

If the HSP is mandated under regulations in the Excellent Care for All Act, 2010 or Ministry of Health and Long-Term Care directive to conduct annual satisfaction

surveys, the HSP will provide the LHIN with an annual summary of satisfaction survey results. The summary will include the reporting of, at minimum:

• Total Number of Patients/Clients/Family Members surveyed for Client Satisfaction; and,

• Total Number of Patients/Clients/Family Members responding positively in response to one of the following questions*:

o “If you needed to be treated again, would you choose to come back to this organization/facility?”;

o “Would you recommend this organization/facility to your friends and family?”; or,

o “Overall, how would you rate the care and services you received at this organization/facility?”.

* actual wording and definitions of “positive” may vary slightly based on survey design.

Reporting is due to the NSM LHIN by June 30 annually.

2019-2020 Schedule C3: LHIN Local Indicators and Obligations

Facility #:




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